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Health Assessment Exam 3 Flashcards

1
Q

What is mental health?

A

Cognitive functioning: thinking, knowledge, problem-solving

And

Emotional functioning; feeling mood behaviors, stability

  • mental health can affect multiple body systems
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2
Q

Why is mental health important?

A

Mental health is a part of a persons, total health

It allows a person to think clearly, respond appropriately, function effectively in ADLs

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3
Q

What are other names for a mental disorder?

A

Mental illness
Psychiatric disorder
Psychiatric illness
Psychological disorder

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4
Q

According to WHO
What is mental health?

A

-Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with enormous stresses of life, can work productively, and is able to make a contribution in his/her community. It is not merely an absence of disease or infirmity

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5
Q

According to American Psychiatric Association
What is a mental disorder?

A

Any condition, which is characterized by cognitive and emotional disturbances, abnormal behaviors, impaired functioning, or any combination of these.

When there are problems with the mind (thoughts) and their mood (feelings)

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6
Q

What things contribute to a mental disorder?

A

External:
-environmental conditions
-Chemicals
-Social factors (socioeconomics)
-culture
-spirituality
-lifestyle choices
-exposure to violence

Internal
-genetics
-Psychological disorders/development
-personality factors
-spiritual factors
-neurological systems / damage to them

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7
Q

Who has the highest incident of mental disorder?

A

LGBT youth

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8
Q

What is a nurses role in mental health?

A

Initial assessment which includes
-Screening for past and present mental condition
-Observation
-Communication
-Administering questionnaires
-Ensuring information from results
-referrals

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9
Q

Substance abuse regarding mental disorder

A

-one of the most persistent conditions affecting mental health
-substance abuse can lead to dependence syndrome
-substance abuse can become a priority in people’s lives

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10
Q

Substance abuse: marijuana
Regarding mental illness

A

-legalization has created more issues
-misuse can lead to other substance abuse
-there are different varieties available with different THC levels

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11
Q

Cultural considerations regarding mental illness

A

-Substance abuse, violence, HIV, risk, depressive symptoms, and Socio economic conditions are directly linked to health disparities among Latinas

-Eye contact and facial expression may differ among cultures

-Perception of illness especially illness associated with mood and mental status vary across cultures
(culture bound syndromes)

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12
Q

What type of subjective data do you collect during a mental status assessment?

A

-appearance
-General behavior
-Cognitive function
-Memory
-Thought process
-The use of questionnaires/tests
-Biographical data
-History of present health concern
-Personal health history
-Family history
-lifestyle and health practices

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13
Q

What is biographical data and collecting a mental health history

A

-Name
-Address
-Phone number
-Age
-Date of birth
-Gender
-Gender identity
-Marital status
-Education level
-Employment

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14
Q

What questions do you ask when collecting a history of present health concerns for mental illness?

A

-What is the most urgent health concern?
-Why are you seeking health care?
-Do you have any other problems?
-Do you have headaches?
-trouble breathing?
-heart palpitations?
-insomnia?
-irritability/mood swings?
-Fatigue?
-suicidal/homicidal thoughts?
-Hallucinations?

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15
Q

What questions do you ask when collecting a personal health history for mental illness?

A

-have you received medical treatment!
-Have you been hospitalized before?
-Have you received counseling before?
-Do you have a history of head injury, meningitis, encephalitis, stroke?
-Have you ever served an active duty military? (TBI)

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16
Q

What questions do you ask when collecting a family history for mental illness?

A

-do you have a history of mental illness?
-Any health problems, such as anxiety, depression, bipolar, schizophrenia
-Any family history of dementia?

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17
Q

What lifestyle/health practices can affect mental illness?

A

-What is a typical day like?
— does your health concern affect your ADLs?
-What is your energy level?
-What are your usual eating habits over 24 hour period?
-What are your bowel patterns?
-What are your sleep patterns?
-What are your exercise regiment?
-Do you drink caffeine, how much?
-Do you drink alcohol, how much?
-Do you take any prescribed or OTC meds?
-Do you take any opioids?

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18
Q

What objective data do you collect during a mental health assessment?

A

-level of consciousness
-mental status
-cognitive abilities

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19
Q

What are the different levels of consciousness?

A

Stuporous
Coma
Obtunded
Lethargy

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20
Q

What objective data do you collect when assessing the mental status portion of a mental health assessment?

A

-Posture, gait, body movements
-behavior and effect
-Dress and grooming
-Hygiene
-Facial expressions
-speech
-Mood, feelings, expressions
-Thought process and perceptions

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21
Q

What objective data do you collect when assessing the cognitive abilities portion of a mental health assessment?

A

-orientation
-Concentration
-Recent memory
-Remote memory
-Use of memory to learn new information
-Abstract reasoning
-Judgment
-Visual, perceptual, and constructional ability
-Mini cog
-SLUMS dementia / Alzheimer’s test exam

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22
Q

How do you conduct a mini cog test?

A

1) instruct the client to remember three unrelated words, and repeat them back

2) instruct client to draw the face of a clock and note certain times by drying hands of the clock

3) ask the client to repeat three previously stated words

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23
Q

What questionnaires are used when assessing level of consciousness

A

-Glasgow coma scale
-mini cog

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24
Q

What is / How do you use SLUMS (st. Louis University mental status)

A

-an examination tool used to assess confidence function for dementia/Alzheimer’s

-the lower the score, the more likely to have dementia.

WITH HS DIPLOMA
30-27 = Normal
26-21 = Mild
20-1 = Dementia

NO HS DIPLOMA
30-25 = normal
25-20 = mild
19-1 = dementia

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25
Q

Explain when, and how to use the CAGE self assessment tool

A

C: cut: have you ever felt you should cut down on alcohol intake?
A: annoyed: have people annoyed you like criticizing you’re drinking?
G: guilty: have you ever felt bad or guilty about drinking?
E: eye-opener: have you ever had a drink first thing in the a.m. to study nerves, or to get rid of a hangover?

-Assesses a persons dependency on alcohol
-used with alcohol testing to identify at those clients
-has also been used to detect alcohol dependence in trauma center populations
-yes/no answers: each, yes, will increase the risk of alcohol dependency

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26
Q

Interview questions to assess psychosocial and why to ask them?

A

-how old are you?
-what is your birth date?
-Gender
-which gender do you identify?

Why?
-information helps determine reference point with which their psychosocial developmental level and appearance can be compare d

-women have higher risk of depression and anxiety

-men have a higher incidence of substance abuse and psychological disorders

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27
Q

Interview questions to assess moral development?

A

-do you have suicidal thoughts
-do you have through did wanting to hurt or kill anyone?
-do you have hallucinations? (What do you see/hear?)
-do you hear voices? (Do they tell you to hurt yourself or others?)

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28
Q

How to conduct a general screening for mental status and risk for substance abuse?

A

-observe level of consciousness
-Observe posture, Gait, body movements
-Observed behavior and effects
-Ask if they drink alcohol, type and how often
-Ask if they use illicit drugs, type, and how often
-Dress and grooming
-Facial expressions
-Speech
-Mood, feelings, expressions
-Thought processes and perceptions (any self injuries or Suicidal Tendencies)
-Orientation
-Concentration
-Reset and remote memory

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29
Q

How to conduct a focused screening for mental status and risk for substance abuse?

A

All the questionnaires…

PHQ-9 (assess depression)
-quick inventory of depressive symptomatology
-C-SSRS (suicidal risk)
-SBIRT (identify, reduced, prevent abuse of drugs/alcohol)
-ADIT (alcohol related disorders)
-generic, depression, scale
-SAD PERSONS
-Abstract reasoning
-SLUMS (Alzheimer’s/dementia)
-Judgment ability
-Visual, perceptual, and constructional ability
-Delirium verse other cognitive impairment (identify the cause of confusion)

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30
Q

What is the Glasgow coma scale?
GCS

A

1) eye-opening response
-Spontaneous opening (4)
-To verbal command (3)
-to pain (2)
-no response (1)

2) most appropriate verbal response
-Oriented (5)
-Confused (4)
-Inappropriate words (3)
-Incoherent (2)
-no response (1)

3) most integral motor response (arm)
-obeys verbal commands (6)
-Localizes pain (5)
-Withdraw from pain (4)
-flexion (3)
-Extension (2)
-no response (1)

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31
Q

How to use AUDIT (alcohol use disorder is identification test)

A

Interview the client for alcohol abuse

Use the following questions:
-How often do you have a drink containing alcohol?

-how many drinks contain alcohol? Do you have on a typical day when you were drinking?

-How often do you have 5 or more drinks on one occasion?

-how often during the past year have you found that you were not able to stop drinking once he has started?

-How often during the past year have you failed to do what was normally expected from you because of drinking?

-how often during the past year have you needed a first drink in the morning to get yourself going after a heavy drinking session?

-how often during the past year have you had a feeling of guilt or remorse after drinking?

-How often during the past year have you been unable to remember what happened the night before because you had been drinking?

-have you or someone else been injured as a result of your drinking?

-Has a relative or friend or doctor or another health care worker been concerned about your drinking or suggested you cut down

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32
Q

Cause and confusion: to assess for causes of confusion in a client

What are the 6 areas

A

1) duration
2) onset
3) attention
4) memory
5) alertness
6) thinking/judgment

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33
Q

Cause and confusion: to assess for causes of confusion in a client

(6) answers for Dementia

A

For Dementia

1) Duration: chronic (does not resolve)
2) Onset: chronic
3) Attention: generally normal attention
4) Memory: recent and remote memory impaired
5) Alertness: generally normal alternates
6) thinking/alertness: may have word finding difficulties, judgement may be poor

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34
Q

Cause and confusion: to assess for causes of confusion in a client

(6) answers for Delirium

A

For Delirium

1) Duration: hours to weeks
2) Onset: acute onset
3) Attention: impaired/fluctuating attention
4) Memory: recent and immediate memory impaired
5) Alertness: fluctuates between lethargic and hypervigilant
6) thinking/alertness: disorganized thinking, slow or accelerated

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35
Q

Cause and confusion: to assess for causes of confusion in a client

(6) answers for Depression

A

For Depression

1) Duration: can last weeks to months or years
2) Onset: often abrupt onset
3) Attention: distractingly but minimal impairment of attention
4) Memory: island of intact memory
5) Alertness: alert
6) thinking/alertness: thinking intact though with themes of helplessness or self-prediction

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36
Q

What is the quick inventory of depressive symptomology?

A

A self report that is used to assess for indications of depression and a client

Patient will select one response to each item that is most appropriate to how they have been feeling over the past 7 days

-find asleep
-Sleep during night
-Waking up too early
-Sleeping too much
-Feeling sad
-Decreased appetite/increased appetite
-Decrease wait/increase weight
-Concentration/decision making
-Perception of self
-Thoughts of own death or suicide
-General interest
-Energy level
-Feeling more sluggish than usual
-Feeling restless (agitated, not relaxed, fidgety)

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37
Q

What is SAD PERSONS?

A

suicide risk tool to assess a client suicide risk

S = sex
A = age
D = depression
P = previous attempts
E = ethanol abuse (alcohol)
R = rational thinking loss
S = Social supports lacking
O = organized plan
N = no spouse
S = sickness

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38
Q

What are abnormal findings in level of consciousness

A

-Stuporous
-coma
-Obtunded
-Lethargy
-Decerebrate posture: hands down and flexed out
-Decorticate posture: hands clenched and brought up towards body

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39
Q

What are abnormal findings in sources of voice and speech problems?

A

-Dysphonia
-Cerebellar dysarthria
-Dysarthria
-Aphasia
-Wernicke aphasia
-Bracha aphasia

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40
Q

How to use clinical judgments when analyzing mental status and substance abuse risks

A

1) select the clients concerns
-Opportunity to improve health
-Risk for client concerns
-actual client concerns

2) selected collaborative problems that need to be monitored and treated by both nursing and primary healthcare provider
-Cluster cues to detect potential collaborative problems
-Monitor

3) referral to primary care provider for sudden, memory loss, and extreme confusion
-notice if signs and symptoms require psychiatric medical diagnosis and treatment for primary care provider as necessary

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41
Q

What is important for communicating interview in assessment findings for mental illness for documentation

A

-make sure to validate all collected data
* ask extra questions if needed
* verify data with another healthcare, professional
* compare, subjective, and objective findings
* verify data is reliable an accurate

-Document following healthcare facility or agency policy

-Document assessment findings by describing patient response instead of labeling the behavior

-Use SBAR

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42
Q

Describe the focus of the different theorists and developmental theories (3)

A

Erickson = psychosocial
Piaget = Cognitive
Kohlberg = Moral

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43
Q

What are the two main concepts that developmental theories are based on?

A

Growth: addition of new skill or components

Development: improvement of existing skills or components

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44
Q

What is Erickson’s developmental theory

A

-Psychosocial: intrapersonal and interpersonal responses of a person to external events

-Believe that a persons personality continues to evolve throughout their life

Influenced by : society, culture, history, biophysical, cognitive

8 stages

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45
Q

What are the eight stages of Ericksons developmental theory?

A

1) infant: trust vs mistrust

2) toddler: autonomy vs shame and doubt

3) preschooler: initiative vs guilt

4) school aged: industry vs inferiority

5) adolescent: identity vs role confusion

6) young adults: intimacy vs isolation

7) middle-age: generatively Vs stagnation

8) older adult: integrity vs despair

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46
Q

What is Ericksons infant stage

A

Infant: birth - 1 year
Stage: trust vs mistrust

Learning to trust self, others, and the environments

If an infant does not pass this stage (or has a negative resolution) they become suspicious / fearful

If an infant passes this stage (or has a positive resolution) they develop drive and hope to

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47
Q

What is Stuporous?

A

awakes to vigorous shake, or painful stimulus, but returns to unresponsive sleep

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48
Q

What is Obtunded ?

A

opening eyes to loud voices, responding slowly with confusion, seeming unaware of environment

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49
Q

What is coma?

A

remaining unresponsive to all stimuli, eyes stay closed

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50
Q

What is lethargy?

A

opening, eyes, answering questions, and falling back to sleep

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51
Q

What questionnaires are used to assess depression?

A

-PHQ – 2
-PHQ – 9
-quick inventory Depressive symptomatology (Self report) *over the past 7 days
-generic depression scale

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52
Q

What questionnaires would you use to asses risk for suicide?

A

-C-SSRS (Columbia suicide, severity, rating scale)
-Sad persons (suicidal risk assessment tool)

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53
Q

What questionnaire is used to asses drug/alcohol abuse?

A

-CAGE
-AUDIT (alcohol use disorder, identification test)
-Clinical institute withdrawal assessment scale
-SBIRT (screening, belief intervention, and referral to treatment )

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54
Q

What questionnaire is used to assess for PTSD

A

-DSM-5

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55
Q

What questionnaires are used to assess dementia/Alzheimer’s?

A

-SLUMS ST. LOUIS UNIVERSITY MENTAL STATUS

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56
Q

What is the PHQ-2

A

Questionnaire to assess depression. Asking two questions:

During the past month, have you often been bothered by:

1) little interest or pleasure in doing things?

2) feeling down, depressed or hopeless?

If yes is answered to either question, complete PHQ-9

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57
Q

What is decerebrate posture?

A

hands down and flexed out

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58
Q

What is Decorticate posture?

A

hands clenched and brought up towards body

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59
Q

What is Dysphonia?

A

voice is volume disorder caused by laryngeal disorder or impairment of X cranial nerve

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60
Q

What is Cerebellar Dysarthria?

A

irregular, uncoordinated speech caused by multiple sclerosis

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61
Q

What is Aphasia?

A

difficulty production or understanding language caused by motor lesion in dominant cerebral hemisphere

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62
Q

What is Wernicke Aphasia ?

A

rapid speech at lax meaning caused by lesion in posterior superior temporal lobe

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63
Q

What is Bracha Aphasia?

A

slow speech with different articulation, but fairly clear meaning caused by lesion in posterior inferior frontal lobe

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64
Q

What are the different mental status affects?

A

-Euthymic
-Constricted
-blunted
-flat
-labile
-inappropriate

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65
Q

What is euthymic?

A

Normal, steady, tranquil mental state

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66
Q

What is constricted?

A

A mildly diminished range or intensity of emotional expression

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67
Q

What is blunted?

A

Markedly diminished emotional expression

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68
Q

What is flat?

A

A severely reduced emotional expression

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69
Q

What is labile ?

A

Irregular and severe mood swings

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70
Q

What is inappropriate?

A

Emotional responses that are not in keeping with the situation or are incompatible with expressed thoughts or wishes, such as smiling when told about the death of a friend

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71
Q

What is Ericksons toddler stage

A

Autonomy vs shame/ doubt

Having control without loss of self esteem.

Negative Resolution leads do doubting of ability’s and feelings of shame.

Positive resolution leads to self confidence and will power

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72
Q

What is Ericksons preschooler stage

A

Initiative vs guilt

Sense of moral responsibility

Negative response leads to feelings of disapproval

Positive resolution leads to direction and purpose

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73
Q

What is Ericksons school age stage

A

Industry vs inferiority

Physical independence from parents

Negative response leads to feelings of failure positive response leads to competence performing tasks

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74
Q

Ericksons adolescent stage

A

Identity Vs role confusion

Emotional independence from parents

Fusing of several identities into one

Negative resolution leads to confusion and non focused.

Positive resolution leads to devotion and fidelity

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75
Q

Ericksons young adult stage

A

Intimacy versus isolation

Committing to relationships, whether their social or intimate

A negative resolution needs to loneliness and poor development of relationships

A positive resolution leads to affiliation in love

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76
Q

Ericksons middle-age stage

A

Generatively Vs stagnation

Giving back to the younger generation

A negative resolution leads to selfishness, shallow involvement in the world and a little psychosocial growth

A positive resolution is to production and care

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77
Q

Ericksons older adult stage

A

integrity versus despair

Acceptance of life lived as well as acceptance of death as it’s entity

A negative resolution leads to regret, discontent and pessimism

A positive resolution leads to renuncication and wisdom

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78
Q

Piaget’s theory of cognitive development

A

He focused on HOW a person learns not about what they are learning.

The process of obtaining an understanding about one’s world

Cognitive development occurs due to how someone organized and adapts to how they perceive their environment.

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79
Q

What is Piaget’s concept theory made of (4)

A

Schema
Assimilation
Accommmodation
Equilibration

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80
Q

What is schema

A

Thought, emotional, memory, movement of body or sensory experience 

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81
Q

What is assimilation?

A

When a stimulus or information is joined with an already existing schema

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82
Q

What is accommodation?

A

The creation or accommodation of a new schema

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83
Q

What is equilibration ?

A

Balance between assimilation and accommodation

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84
Q

What are Piaget’s 4 stages?

A

Sensorimotor
Preoperational
Concrete operational
Formal operational

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85
Q

What is sensorimotor

A

Age: 0-24 months total. Stages are broken up by age

Birth to 1 month: basic reflux (suckling)

1-4 months: discovers enjoyment thru random behaviors and repeats them (smiling or sucking thumb)

4-8 months: related own behavior to a change in environment (shaking a rattle and hearing sounds or moving a spoon to eat)

8-12: can coordinate more than one thought pattern to reach a goal (repeating throwing an object on the floor)

12-18: recognized permanence of objects even if they are out of site also can understand simple commands

18-24: begins to develop reasoning, and can anticipate events

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86
Q

What is preoperational?

A

When the use of symbols & language begin and pictures increase.

It’s divided into two stages:
Preconceptual (2-4)
Intuitive (4-7)

In preconceptual phase a word is assigned to several similar things (all 4 legged animals get called by their pet dogs name)

As they move into intuitive stage, they start to realize the ability of a certain word to represent a specific object

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87
Q

What is fundamental ecocentrism ?

A

Everything is as the child perceives it and doesn’t believe things can be different elsewhere

Ex: if I’m going to bed now, every child everywhere must be going to bed.

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88
Q

What is centration?

A

Tends to focus on one aspect of an object or experience

Ex: two rows 6 Pennie’s, one row has them spaced out more so child lays the longer row has more

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89
Q

What is limited transformation?

A

Cannot comprehend the steps of how objects can change

Ex ice melts to water

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90
Q

Action rather than abstraction

A

Perceives an event as if actually loving it again

Ex when asked about riding in a toy car, they may imitate turning the wheel

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91
Q

What is irreversibility ?

A

Unable to follow a line of reasoning back to the beginning.

Ex: retracing steps while in a walk

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92
Q

What is transductive reasoning ?

A

Things specific to specific - if two things are alike in one aspect the. They are alike in all aspects

Ex: seeing a beetle at the park is the same beetle in their backyard

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93
Q

What is Animism ?

A

Believes inert objects are alive with feelings and can thing and function with intent

Ex: vacuum is eating toys

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94
Q

What is concrete operational?

A

Age 7-11
Starts to think and reason logically about objects in the environment.

Reasoning is limited to concrete objects and events (what is) and not abstract (what might be).

Inductive reasoning has started and can start to consider viewpoints of others.

Can use a clock, understand weeks, months, year, math, organize, classify, capable of money management

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95
Q

What is formal operational?

A

Age: 11-15+
Starts to problem solve in real world and theoretical situation. Can think about past, present and future logically and flexibility.

Can think about symbols and abstractly. Can generate multiple solutions Can use deductive reasoning.

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96
Q

Kohlberg theory

A

Moral development that is influenced by cognitive structures.

Justice is the goal of moral judgement

Has 3 stages:
Preconventional
Conventional
Postconventional

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97
Q

What is preconventional (premoral)

A

Kohlberg’s 1st stage
*orientation to punishment and obedience
(Preschool - early school age)
&
*orientation to instrumental relativism (individual purpose)

(Late preschool - late school age)

Part one: hard to consider two points of view in a moral argument.
-Conforms to rules given by authority figures to avoid punishment
-punishment, obedience, reward are all involved in this level
-perception of good and bad develop
-punishment means action was “wrong”

Part 2: Starting to become aware that people can have different perspectives in a moral dilemma. Desires reward for “right” act

**viewed infants and young toddlers as naive and egocentric and not capable of moral reasoning

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98
Q

What is conventional stage? (Maintaining external expectations of others)

A

Kohlberg’s 2nd stage
*orientation to interpersonal concordance (unity and mutuality)
(School age - adulthood)
&
*orientation to maintenance of social order (law and order)
(Adolescent through adulthood)

Part one: Attempts to adhere to perceived norms. I wants to maintain approval and affection of friends and relatives. Wants to be considered “good person”

Part two: attempts to make decisions and behave by strictly conforming to fixed rules and the written law. “Rights of doing one’s duty”

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99
Q

What is postconventional? (Maintaining internal principles of self)

A

Kohlberg’s 3rd stage
*orientation to social contract legalism
(Middlescence - older adult *only 10-20% of dominant American culture attain this stage)
&
*orientation to universal ethical principle
(Middlescence - older adulthood *few ppl either attain or maintain this stage

Part one: rules and laws are changeable with due process. “Right” is respecting individual rights while emphasizing the needs of the majority.

Part two: making decision and behaving based on internalized rules, on conscience instead of social law

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100
Q

Things to collect for psychosocial, cognitive, and moral development during initial interview

A

Subjective
Objective
Biographical
Current health
Health history
Family history
Lifestyle and health practices

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101
Q

What are subjective/objective data findings regarding psychosocial (youth)

A

Self acceptance
independence from parents
Involved in close relationships
Good problem solver
Have social group

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102
Q

What are subjective/objective data findings regarding psychosocial (middle adults)

A

Have healthy life patterns
Satisfaction from seeing others grow
Long term relationship
Have stable home
Find pleasure in their profession
Take pride in family and accomplishments
Contribute to the community

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103
Q

What are subjective/objective data findings regarding psychosocial (older adults)

A

-Recognizes changes that are due to aging
-Maintain relationships with kids, grandkids, and relatives
-Has continued interest outside of self and home
-Adjust to death of relatives, spouse
-Find meaning of their past life and accept death as inevitable
-Review accomplishments

104
Q

What are subjective/objective data findings regarding cognitive assessment (young adults)

A

-assume responsibility and make independent decisions
-self evaluated strengths and weaknesses
-identify and explore multiple options and outcomes
-seek career mentors
-have future realistic plans

105
Q

What are subjective/objective data findings regarding cognitive assessment (middle adults)

A

-differentiate goals, wishes and realities
-identify factors that give life meaning and continuity
-share knowledge with others
-emotions don’t affect cognitive decision making
-seek new ways to improve knowledge
-adapt quickly to change and new knowledge

106
Q

What are subjective/objective data findings regarding cognitive assessment (older adults)

A

-maintain maximal independence with ADLs
-look for ways to find satisfaction with life
-determine realistic plans for future including own mortality

107
Q

What are subjective/objective data findings regarding moral assessment (young adults)

A

-states priorities when making moral decisions
-perceives having approval of family
-perceived having approval of peers
-perceive having approval of authority figures
-perceived having approval of significant other

108
Q

What are subjective/objective data findings regarding moral assessment (middle adults)

A

-states priorities when making moral decisions
-focus more on law and order or individual rights when making a decision.
-express willingness to stop unhealthy behavior and change lifestyle patterns for a higher level of eill was

109
Q

What are subjective/objective data findings regarding moral assessment (older adults)

A

-states priorities when making moral decisions
-view rules and laws as changeable using legal means
-makes decisions consistently on internalized rules and in terms on conscience
-believe in equality for every person

110
Q

Normal vs abnormal findings of psychosocial assessment (young adult)

A

Normal:
-intimacy
-self efficacy
-close caring relationships
-adult friendships with parent and siblings

Abnormal:
-isolation
-cannot express emotions
-loneliness
-addictive behaviors

111
Q

Normal vs abnormal findings of psychosocial assessment (middle adult)

A

Normal:
-generativity
-establish nurturing relationships
-mentoring / giving to future generations

Abnormal:
-stagnation
-has not accomplished developmental task
-unable to give to future generations

112
Q

Normal vs abnormal findings of psychosocial assessment (older adult)

A

Normal:
-integrity
-thinks their life was good
-reminisced about life

Abnormal:
-despair
-not grateful for life
-bitterness

113
Q

Normal vs abnormal findings of cognitive assessment (young adult)

A

Normal:
-uses sensorimotor thought and learning
-alert to both internal and external stimuli
-cognitive regression when stressed
-deductive reasoning
-interested in learning / does at own pace

Abnormal:
-cognitive arrest occurred
-difficulty with abstract thinking
-difficulty understanding info written in textbooks

114
Q

Normal vs abnormal findings of cognitive assessment (middle adult)

A

Normal:
-readjust and modified goals
-increasing creativity
-provides mentorship

Abnormal:
-difficulty remaining current at work and meeting expectations
-not made adequate or realistic plans for future
-don’t have in depth explanations and rationale when teaching

115
Q

Normal vs abnormal findings of cognitive assessment (older adult)

A

Normal:
-share expertise with others
-reminisce on life and tell stories
-gradual transitions
-demonstrates flexibility
-solidify concepts of life or death
-makes realistic decisions

Abnormal:
-profits from assistance from others with tasks such as taking meds or ADLs

116
Q

Normal vs abnormal findings of moral assessment (young adult)

A

Normal:
-moral reasoning
-maintains expectations and rules of family, groups and society
-obeys laws and respect authority
-guilt can be a motivator to do the right thing

Abnormal:
-behaves solely for self satisfaction
-infringes on rights or comfort zone of others

117
Q

Normal vs abnormal findings of moral assessment (middle adult)

A

Normal:
-positive personal moral choices
-learned from their mistakes
-challenges authority as young adult

Abnormal:
-maladaptive coping mechanisms
-fears authorities with hopes of not getting caught

118
Q

Normal vs abnormal findings of moral assessment (older adult)

A

Normal:
-respecting individuals but emphasizing the need of the majority
-absolute justice is needed for every individual
-may be willing to risk external punishment
-speaks one’s mind

Abnormal:
-harming self or others
-try to avoid disapproval from others

119
Q

How do you use clinical judgements regarding analyzing developmental level?

A

-identify abnormal findings
-cluster data
-look for opportunity to improve (relationships and mental health)
-assess risk for clients concerns
*violent behaviors towards self
*violent behaviors towards others
*risk for poor relationship
*risk for suicide
-assess clients concerns
*depended on individuals level of assessed development
*anxiety
*poor body image
*delayed development
*family dysfunction

120
Q

What is domestic violence?

A

Pattern of abusive behavior in a relationship that is used by another to gain/maintain control over the other person

121
Q

What is family violence?

A

Violent or threatening behavior, or another other form of abuse that co told a member of the family

122
Q

Types of physical violence

A

Slapping
Hitting
Kicking
Punching
Burning

123
Q

Types of emotional violence

A

Threats of harm
Financial harm
Harm to child or pet
Suicide
Harassment stalking
Insults and verbal abuses
Isolation
Intimidation
Mind games
Throwing objects

124
Q

Types of sexual abuse

A

Incest
Rape

125
Q

What are McCue’s 5 theories of violence?

A

1) Psychopathology
2) social learning
3) biological theory
4) family systems
5) feminist

126
Q

What is McCue’s psychopathology theory?

A

People who do harm have personality disorders

127
Q

What is McCues social learning theory?

A

Violence is a learned behavior from childhood

128
Q

What is McCues biological theory?

A

Physiologic changes from childhood trauma, head injuries, or through heredity can lead to violent behavior

129
Q

What is McCues family systems theory?

A

Violence grows through family system function, but Sime criticize this theory as blaming the victim

130
Q

What is McCues feminist theory?

A

Male/female inequality in patriarchal societies leads to violence

131
Q

What is Walker’s cycle of violence?

A

Criticism
Acute battering
Honeymoon

132
Q

What happens in the criticism phase of abuse?

A

-the tension building phase
-abuser makes unrealistic demands that can’t be met. Then frustration leads to anger shoving or slapping.
*victim often blames themselves for not being able to meet the demand

133
Q

What happens in the acute bartering phase of abuse?

A

Could be triggered by something minor, but results in violence lasting up to 24 hours. Victim can rarely stop abuser

134
Q

What happens in the honeymoon phase of abuse?

A

Period of reconciliation. Occurs after violent episode. Abuser is loving and makes false promises to stop. Acts very attentive to victim until cycle starts over

135
Q

What is the cycle of domestic violence?

A

Similar to walkers cycle, but with 7 stages:
Abuse
Guilt
Rationalization
“Normal” behavior
Fantasy
Planning
Setup

136
Q

What are the short term effects of emotional abuse?

A

Shame, fear, confusion
Physiological: aches, pains, muscle tension

137
Q

What are the long term effects of emotional abuse?

A

Insomnia, chronic pain, anxiety

138
Q

What can happen to children experiencing emotional abuse?

A

Physical: chronic health conditions, impaired brain development, brain injury, sleep disorders
Psychological, isolation, fear, inability to trust, low self esteem, depression, worthlessness

Behavioral: Some regression, adolescent issues, substance abuse, delinquency, truancy, pregnancy, sexual risk taking, high chance of getting raped

Societal: cost for child maltreatment facilities, juvenile and adult criminal activity, mental Illness

139
Q

What is intimate partner violence (IPV)

A

Physical, sexual, or psycho local harm by current or former partner.

140
Q

What is the leading cause of murder and injury-related death for pregnant women?

A

IPV

141
Q

What psychological effects do older adults experience if abused

A

Shame, fear, condition

This can lead to high levels of distress and depression. They can develop anxiety, helplessness and PTSD

142
Q

What physical effects do older adults experience if abused

A

Insomnia, chronic pain, anxiety

Welts, sounds, injuries, nutrition and hydration issues, increases susceptibility to new Illness

143
Q

How to assess for elder abuse

A

It can be difficult bc of persons isolation, fear of perpetrator, and inability to report bc of cognitive impairment.

Use EASI : elder abuse suspicion index assessment tool

144
Q

What is school violence

A

Bullying
Cyber bullying
Punking

145
Q

What is human trafficking?

A

People who are deprived of their freedom to leave the work and are exploited further by traffickers stealing any identity documents often wages

Could be :
Farm/factory/restaurant
Sexual
Drug mules
Child soldiers
Debt bondage

146
Q

What are war crimes?

A

Crimes committed against “enemy” that are outside of the Genova code

Make sure when treating patients if war crimes assess for PTSD

147
Q

Subjective data regarding violence

A

-examine personal feelings, believes, biases that may interferes with perception and interpretation of what is going in

-assess for physical, psycho, economic and sexual abuse

-observe others presence at visit and assess without them in room

148
Q

What to obtain for medical history regarding violence

A

Biographical date
Present health hx
Family hx
Lifestyle and health practices

149
Q

Gaining medical history for suspected child abuse

A

-establish reassuring environment
-be comfortable with questions
-be calm and accepting
-do not coerce
- know and understand developmental stage child is in
-be direct without leading
-avoid yes/no questions
Give little info in questions

150
Q

What is HITS assessment used for?

A

Used to screen for IPV

Hurt
Insult
Threaten
Scream

151
Q

What is abuse assessment screen ?

A

Used to screen for abuse

1) within the last year
2) since you’ve been pregnant

152
Q

What is danger assessment?

A

Used to screen for risk of homicide based on violence in relationships

153
Q

What is a SANE?

A

Sexual assault nurse examiner

Complete focused gyne exam is sexual assault is suspected

154
Q

What to ask for COLDSPA regarding violence?

A

C: describe it (symptom) what’s happening?
O: when did it start?
L: where does it happen?
D: how long does it last?
S: how bad is it? Rate on scale from 1-10
P: when does it happen or timing?
A: anything make it better or worse?

155
Q

What percentage of information needed to make a diagnosis is obtained through appropriate history taking and questions?

A

80%

156
Q

What ages if pediatrics are susceptible to violence?

A

All ages

157
Q

When during pregnancy are women more susceptible to violence?

A

During and after

158
Q

What ages of older adults are more susceptible to violence?

A

55+

159
Q

What should you examine on patent regarding violence?

A

General appearance, dress, hygiene
Mental status
Skin
HEENT
abdomen, GI
MS, neuro

160
Q

How to set up a safety plan with patient

A

-ask have you/ do you questions
*bag packed, told neighbors and ask to call if the my hear something, have code word for kids, know where to go, removed weapons from home

-have they gathered following
*cash, SS card, birth certificates, drivers license, rent and utility receipts, bank account numbers, insurance policy and numbers, important phone numbers

161
Q

What are the four broad categories of child a use?

A

Neglect
Emotional abuse
Sexual abuse
Physical abuse

162
Q

What is culture?

A

Shared systems of values, believes and learned patterned of behavior

163
Q

What do the cultural competence process ASKED?

A

Awareness
Skills
Knowledge
Encounters
Desire

164
Q

What is minority?

A

Group with smaller population numbers

165
Q

What is immigration?

A

Moving from one country to another

166
Q

What is an immigrant

A

One that is not native born, or have not become a permanent resident, alien or new citizen

167
Q

That are CLAS mandated?

A

15 standards created by national standard for culturally and linguistically appropriate services in healthcare

168
Q

What are the 15 standard of CLAS?

A

1) all should receive care with cultural beliefs and practices honored, in preferred language
2) diverse staff
3) ongoing cultural and linguistic training
4) interpreter
5) provide verbal and written notice (in preferred language) that they have a right to an interpreter
6) compliance of interpreter
7) easily understood patient related material
8) written strategic plan
9) conduct clas practices
10) ensure race, ethnicity and language are in EHR
11( ensure bio info is correct and reviews and updated
12) participatory and collaborative relationships
13) conflict and grievance resolution
14) info available to public

169
Q

What is stereotyping?

A

Oversimplified conception, opinion, or believe about an aspect of an individual or group

170
Q

What is ethnocentrism?

A

Universal tendency of humans to think their ways of thinking acting, and believing are the best and only right ways

171
Q

What is acculturation?

A

When someone gives up the traits of their culture of origin to adapt to another

172
Q

Assimilation

A

Gradual adoption and incorporation of characteristics of the prevailing culture

173
Q

Cultural diversity

A

The coexistence of a difference in behavior, traditions, and customs

174
Q

Cultural imposition.

A

Someone imposing their cultural believes onto another

175
Q

Cultural relativism

A

Belief that behaviors and practices of ppl should be judged only from within cultural system

176
Q

Culture

A

Totality of socially transmitted behavior patterns, arts, beliefs, values, customers lifestyles

177
Q

Enculturation

A

Natural conscious and unconscious condition no big process of learning accepted cultural Norma’s, values and roles in society

178
Q

Ethnicity

A

Socially culturally and politically constructed group that holds a common set of characteristics that are not shared by others who are members of the group come in contact with

179
Q

What is subculture?

A

A group of people, with a culture that differentiates them from a larger culture which they are a part of

180
Q

What is worldview?

A

The way, individuals or groups of people look at the universe to form basic assumptions and values

181
Q

What is the main purpose of assessing a patient’s culture?

A

To learn about the patient’s beliefs, and usual behaviors associated with their health and illness

Example: disease causes, caring, expected treatments, daily hygiene, food, preferences, and rituals, religious beliefs, related to healthcare 

182
Q

What is the purpose of the musculoskeleton system?

A

To provide structure and movement for body parts

183
Q

What is the purpose of bones?

A

Store calcium
produce blood cells
* red marrow
* yellow marrow, composed, mostly of fat
206 bones in body

184
Q

What are the two types of bones?

A

Compact bone
Spongy bone

185
Q

Characteristics of compact bone

A

Hard and dents
Make up Shaft outer layers

186
Q

Characteristics of spongy bone

A

Numerous spaces
Ends in Center phone

187
Q

What is the periosteum?

A

Covers the bones
Contains osteoplast and blood vessels to promote nutrition in the formation of new phone tissue

188
Q

What are the three types of skeletal muscles?

A

Skeletal
Smooth
Cardiac 

189
Q

How many muscles are there

A

650

190
Q

What is a joint?

A

Where two or more bones meet

They allow ROM

191
Q

What are the three types of joints?

A

Fibrous
Cartilaginous
Synovial

192
Q

What is a fibrous joint?

A

An immovable joint that is Joined by fibrous, connective tissue

193
Q

What is cartilagineus joint?

A

A joint join by cartilage

194
Q

What is a synovial joint?

A

Synovial fluid fills the space between bones to help lubricate and promote sliding movement

195
Q

How are bones in synovial joints joined

A

By ligaments

196
Q

What are ligaments

A

Strong dance band of fibrous connective tissue

197
Q

What is a bursae?

A

Small sacs filled with synovial fluid that cushion the joint

198
Q

What is the temporomandibular bone?

A

Temporal bone and mandible

Opens and closes mouth
Protects and retracts jar
Move job from side to side

199
Q

What is the elbow?

A

Ulna and radius of lower arm, and a humorous of upper arm
-Contain synovial membrane and several bursae
-Provides flexion and extension from
-supination and pronation of the forearm

200
Q

What is the sternoclavicular?

A

The junction between the manubtium of the sternum in the clavicle

-no obvious movements

201
Q

What is the shoulder?

A

Head of the humerus in the glenoid cavity of the scapula
-Has subacromial and subscapular brusae
-Fluctuation extension, abduction, abduction, circumduction, and rotation

202
Q

Articulation of wrist

A

They are lined with synovial membrane

Flexion, extension, hyper extension, adduction, radial, and ulnar deviation

203
Q

Articulation of the fingers and thumb

A

Lined with synovial membrane

Fingers: flexion extension, hyper extension, abduction, and circumduction

Thumb : Flexion, extension, and opposition

204
Q

Articulation of the vertebrate

A

Flexion, hyper extension, lateral bending, rotation

205
Q

Articulation with the hip

A

Flexion with knee flexed and knee extended

-Extension hyperextension, circumduction, rotation, adduction, abduction

206
Q

Articulation with the knee

A

Flexion and extension

207
Q

Articulation with the ankle and foot

A

Ankle: plantar flexion dorsiflexion
Foot : inversion and eversion
Toes: flexion, extension, abduction, and adduction

208
Q

What are cultural and genetic variations regarding bones

A

African Americans: thicker frontal bones
Causations: thicker parietal bones

Radius and ulna length vary depending on ethnicity

209
Q

How do vertebrae vary among ethnicities?

A

Most people have 24 vertebrae

11% of African-Americans have 24
12% of Eskimo and native American men have 25

210
Q

What is osteoporosis?

A

Demineralization of bones causing them to become porous and fragile, making individuals more susceptible to fractures

Progressive with no symptoms

211
Q

Who is mostly affected by osteoporosis

A

Women
(Highest in white females)
(lowest in black males)

212
Q

What things to assess for nursing history regarding MS

A

-Pain
-Stiffness
-Are ADLs affected
-Diet/exercise

213
Q

Current health concerns regarding MS

A

-History of present health condition or concerns
-Any recent weight gain
-describe muscle joint or bone pain

214
Q

Questions for personal health History regarding Ms

A

-Any problems or injuries?
-When was your last tetanus and polio vaccine?

215
Q

Family history questions for MS

A

-Do you have any family history of rheumatoid arthritis gout or osteoporosis?

216
Q

Lifestyle and health habits regarding MS

A

-are you taking any medication?
-Activities that promote health of muscles and bones?
-Do you smoke?

217
Q

Physical exam regarding MS system

A

Posture
Gait
Bone strength
Muscle strength
ROM
Ability to perform ADLs
Perform special test for CTS

218
Q

What are bulge, Ballottememt, and mucmurray tests used to assess?

A

Knee

219
Q

What is the bulge test?

A

Inspection for swelling on the knee.

Client in supine position. Use all of hand to firmly stroke the medial of me upward 3-4 times (this is to displace any accumulated fluid) then press on the lateral side of the knee and look for a bulge on the medial side

Abnormal: bulge of fluid appears on medial side of knee with small amount of joint effusion

220
Q

What is a ballottement test?

A

Text large amounts of fluid in the knee.

Patient lays and supine position, firmly press, non-dominant thumb, and index finger on each side of the patella (This displaces fluid in the suprapatellar bursa) With dominant fingers push the patella down on the femur, feel for a fluid wave or a click.

221
Q

What is McMurray’s test?

A

Used to test for pain or injury in the name of patient complains of giving in or locking

Client in supine position, ask them to flex one knee and hip. Placed an index finger of one hand on either side of the knee, and use other hand to hold the heel of the foot up. Rotate the lower leg and foot. A lot of really slowly extend the knee and notice if there’s pain or clicking.

222
Q

MS system and older adults

A

slower movements
reduce flexibility
decrease muscle strength
reduced elasticity of tendons
joint capsule calcification
Bone density loss
Bone fractures
Osteoporosis
Stiffness

Kyphosis (exaggerated thoracic curve) is common

Bow legged due to decreased muscle control

223
Q

How to test muscles

A

Test strength by applying resistance against the moving part if patient can’t move against resistant, ask him to move against gravity

Inspect and feel for palpable muscle contraction went in motion

224
Q

What are abnormal findings regarding posture and Gait?

A

Slumped shoulders
Spine curvatures
Uneven, weight-bearing
Cannot stand on heels or toes
Toes point in or out
Client lips or shuffled
Has a wide gate

225
Q

What are the three abnormal spine curvatures?

A

Lordosis
Kyphosis
Scoliosis

226
Q

What is kyphosis?

A

Rounded thoracic, convexity and upper back

227
Q

What is scoliosis?

A

Lateral curvature of the spine with an increase in convexity on the side that is curved

228
Q

What is lordosis?

A

Lumbar spine drives inward

Note: some African Americans have larger gluteal prominence that tends to look like lumbar lordosis

229
Q

What can cause flattening of the lumbar curvature?

A

Herniated, lumbar discs, or ankylosing spondylitis

230
Q

What is the nudged test?

A

Testing for fall risk of falling backwards with being nudged

Stand behind client and put your arms around them on the gene sternum

231
Q

Normal findings in the temporomandibular

A

-snapping in clicking can be felt in heard
-Mouth opens wanted to inches
-Jammu is literally wanted to cm
-full ROM

232
Q

What are abnormal findings in the temporomandibular?

A

-Decreased ROM
-swelling
-Tenderness
-crepitus is felt when jaw is palpated in person has arthritis
-Decrease muscle strength
-grating can be heard on client has TMJ decision
-Like a full contraction with cranial nerve V

233
Q

When would you feel crepitus?

A

In temporomandibular when patient has arthritis

234
Q

What are abnormal sternoclavicular joint findings?

A

-Swollen
-red
-Enlarged
-Tender
-Information

235
Q

What are some abnormal findings regarding spine

A

-any abnormal curvatures
-unequal height of hips
-compression fracture
-cervical strain

236
Q

Abnormal findings in shoulder, arm and elbow

A

-flat, hollow, or less rounded shoulders
-Tenderness and swelling
-decreases ROM
-inability to shrug

237
Q

Abnormal findings of the wrist

A

-swelling
-Tenderness
-Nodules
-cysts
-Ulnar deviation

238
Q

What is carpal tunnel syndrome?

A

Tingling
Numbness
Burning
Pain with movement

239
Q

Abnormal findings of the hand and fingers

A

Pain
Tenderness
Swelling
Short fingers
Deformities

240
Q

Abnormal hip findings

A

Instability
Inability to stand
Deformed hips
Tenderness
Edema
Decreased Rom
Crepitus
Inability to abduct

241
Q

What is crepitus?

A

A grating sound, or sensation produced by friction between bone and cartilage, or fractured parts of a bone

242
Q

What are abnormal findings in the knee?

A

Knock knees
Bowed legs
Swelling above / next to patella
Tenderness and warmth
Bulge of fluid on medial knee

243
Q

Abnormal findings of the ankle and feet

A

Laterally deviated great toe
Overlapping of toe
Inflamed bursa
No arches in feet
Calluses
Warts

244
Q

What are the most common sites of Sprains?

A

Ankles

245
Q

Going to perform a focused screening during MS

A

After General routine- any abnormalities require a more focused screening

Is client describes an ability to move a joint or talks about pain.

Make sure to test for symmetry, color, ROM, strength, carpal tunnel, knee tests, lasegue test, CTS, flick signal

246
Q

What is the lasegue test?

A

Patient in supine position, raise one leg while keeping other flat. Raise up until just short of pain then have them dorsiflex their foot. Assess for pain

247
Q

What is CTS?

A

Carpal tunnel syndrome

248
Q

What is flick signal ?

A

Ask patient what they do when symptoms are worse in wrist (carpal tunnel syndrome)

If they flick their wrist like shaking a thermometer, may mean CTS

249
Q

How to assess recent or short term memory?

A

Ask questions about things and events that are currently happening

Example: what they ate for breakfast

250
Q

How to assess for remote memory?

A

Ask question to test long term memory.

Example birth date

251
Q

How to assess for abstract reasoning?

A

Ask how an orange and an apple are different

252
Q

How to assess chief complaint?

A

Ask why they are at the clinic

253
Q

What is Dysarthria

A

Slurring. A defect in muscular control a speech related to lesions of the nervous system, Parkinson’s disease, or cerebral disease

254
Q

What are the rating scales for muscle strength.

A

5: active motion against full resistance / normal
4: active motion against some resistance / slight weakness
3: active motion against gravity / average weakness
2: passive ROM (gravity removed and assistance is used) / poor ROM
1: slight flicker of contraction / severe weakness
0: no muscular contraction / paralysis

255
Q

What tests do you use to assess carpal tunnel?

A

-Phalen test
-Tinel sign
-flick signal
-thumb weakness

256
Q

What is the tinel sign

A

Tests for carpal tunnel
Use finger to percussion lightly over the median nerve (located in inner aspect of the wrist)

Any tingling or shocking sensation

257
Q

What is the Phalen test

A

Assess for carpal tunnel syndrome

Have client place the backs of both hands against each other while flexing the wrists 90 degrees with fingers pointed downward and wrists dangling. Hold for 60 seconds

Assess for tingling, numbness, burning or pain

Gero (5 decks)

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